Faraz Munir-Amyotrophic Lateral Sclerosis-(Pakistan)

Name: Faraz Munir
Sex: Male
Age: 38Y
Diagnosis: Amyotrophic Lateral Sclerosis (ALS)

Before treatment:
The patient felt weak in his left leg17 months ago and the condition got worse with his other three limbs also becoming weaker. He went to a local hospital 1 year ago and he was diagnosed with motor neurone disease. He lost walking ability 8 months ago and had respiration  and swallowing problems 5 months ago. He was unable to speak clearly 4 months ago and at present he is lying on the bed and he can’t take care of himself at all. He feels pain in all his  body joints and he has problems with his four limbs. His respiratory rate is faster than normal, it is hard for him to chew food and he is unable to speak clearly.
His spirit is normal, he eats less food, his sleep is normal, he defecates once in 2-3 days and he feels pain during urination.

Admission PE:
Bp: 125/89mmHg, Hr: 76/min, body temperature: 36.7 degrees. Breathing rate: 20/min. There was no bleeding spots or yellow stains on his skin and mucosa, no tonsil swelling, chest development is normal but chest movement is reduced when he was breathing. The respiratory sounds in his  lower lungs were weak but with no dry or moist rales. The heart beat is strong with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was soft and flat with no masses or tenderness. Liver and spleen were normal, shifting dullness was negative and there was no edema of the legs.

Nervous System Examination:
Patient was alert and his mental status was fine. He had clear speech, the memory, orientation and calculation abilities were normal. Both pupils were equal in size and round, diameter of 2.0 mm and react well to light. Bilateral forehead wrinkle and nasolabial groove are symmetrical, he can close eyes powerfully, he can make the tongue extend out to the lip on the side but with poor tongue muscle movement ability. The tongue muscle had atrophy and fibrillation. Showing the teeth was normal, he can bulge his cheeks but with air leakage, chewing ability was weak, the bilateral soft palate cannot lift well. He had choking when he drank water. His neck was soft with no resistance and he cannot turn his neck freely. The shrug muscle power was 2 degrees, right arm proximal side muscle power was 3 degrees, distal side muscle power was 4- degrees. Left arm proximal side muscle power was 2+ degree, distal side muscle power was 4- degrees. The right hand grip force was 3 degrees, left hand grip force was 3- degrees. The patient had interphalangeal joint contracture. Muscle power of the legs was 2+ degrees. The muscle tone of the arms was increased slightly, the leg muscle tone was high. Bilateral biceps reflex and triceps reflex were normal, tendon reflex in the legs were active. Bilateral ankle clonus, the palm-jaw reflex of both sides, the bilateral Hoffmann sign and the bilateral Babinski sign were all positive. The sensory examinations were normal. Finger opposite movement of both sides were normal.  The patient cannot perform the fast alternate movement, finger to nose or heel-knee-tibia test because of weakness. The meningeal irritation sign was negative.

After the admission he received 3 times nerve regeneration treatment to repair his damaged nerves, replace dead nerves, nourish nerves, regulate his immune system and improve blood circulation. This was done along with rehabilitation training.     

After 14 days treatment his appetite improved, the joint pain reduced, his leg muscle tone decreased and he could now bend his knees. His left leg could lift much better than before, he could lift it up off the bed and keep it there for 3-5 seconds. The grip force of the hands got better also, right hand  was 3+, left hand  was 3 degrees.


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